Healthcare Provider Details

I. General information

NPI: 1154564300
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA AUDIOLOGY ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 ETIWANDA AVE STE 201
TARZANA CA
91356-6135
US

IV. Provider business mailing address

5525 ETIWANDA AVE STE 201
TARZANA CA
91356-6135
US

V. Phone/Fax

Practice location:
  • Phone: 818-578-5093
  • Fax: 888-405-0429
Mailing address:
  • Phone: 818-578-5093
  • Fax: 888-405-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU2631
License Number StateCA

VIII. Authorized Official

Name: DR. JONATHAN C LEITERMAN
Title or Position: AUDIOLOGIST/PRESIDENT
Credential: SC.D.
Phone: 310-360-0332